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I <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: 401 CONSTRUCTION <br /> Premise Address: fid, ��• �� ' a-fi�� Total DepthQ-2�U , <br /> p / � Screen Length (from) (to)_ <br /> Well No.: �� .t d(s-C, Filter Pack (from) (to)_,_ <br /> Bentonite (from) (to)__ <br /> Inspector: Grout (from) (to) <br /> Sf�-�bY(y 0 Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: Ug:t / <br /> Driller: casing <br /> L l height <br /> Consultant-5 <br /> Geologist _ T <br /> ABOVE-GROUND CNAISTY-80X <br /> COIN?IETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Cry <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft• <br /> ft ft. <br /> SAMPLING .: <br /> •lotted <br /> aeaaon 2. <br /> Holding Temperature <br /> Method _= gr1Ha1 Pack <br /> Screening Method =_ <br /> Tracking Sheet - (y/n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot s7- ( <br /> GROU'T'ING Bags <br /> ov Bucke <br /> Depth to water Bags s <br /> Mix Ratios Filter e <br /> Installation Method Surge nQuantity Installed Discusogist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />